NPIMap

Organization Active NPI

Dva Healthcare Southwest Ohio LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fairfield, OH
National Provider Identifier
1720042096
Registry record updated Aug 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
0491DC Issued in OH
Legal business name
DVA HEALTHCARE SOUTHWEST OHIO LLC
Practice address
1210 Hicks Blvd
Fairfield, OH 45014-1921
Phone
(513) 939-1110
Fax
(513) 939-1202
NPI assigned
Apr 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Samuel T Wey
Title
VP, Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 0491DC OH Primary

Addresses

Primary practice location

1210 Hicks Blvd
Fairfield, OH 45014-1921

Mailing address

5200 Virginia Way
Att: L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
3900031000MedicaidKY

Other names 1

  • Fairfield Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070529000064 OH Part A Provider - End-Stage Renal Disease Facility (ESRD) 8820908668 Practice locations: Fairfield, OH

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Dva Healthcare Southwest Ohio LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 8

Organizations listed as members of this organization in the National Provider Directory.

Locations

1210 Hicks Blvd
Fairfield, OH 45014
Phone (513) 939-1120

3497 S Dixie Hwy
Middletown, OH 45005
Phone (513) 422-8098

6 East Ave
Monroe, OH 45050
Phone (513) 539-9261

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787011200000",
    "number": "1720042096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 HICKS BLVD",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "450141921",
            "telephone_number": "513-939-1110",
            "fax_number": "513-939-1202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE SOUTHWEST OHIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-13",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP, LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "OH",
            "license": "0491DC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3900031000",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairfield Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fairfield Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfield, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.